An asymptomatic double aortic arch with separate right vertebral artery and left subclavian artery originating from Kommerell Diverticulum combined with congenital asplenia and absence of celiac trunk
, 2, 3, 4, 1, 5
Abstract
This report describes the unique case of a completely patent Double Aortic Arch (DAA) combined with Kommerell Diverticulum (KD), absence of celiac trunk and congenital asplenia. The anatomical variants described were identified and assessed in a 51-year old female from a computed-tomography angiography (CTA) images with 3D-volume rendered reconstructions during her follow-up after hysterectomy. The reconstructed CTA images showed a DAA with the left common carotid artery stemming from the hypoplastic left aortic arch while the left subclavian artery originated from a KD in the descending thoracic aorta. A symmetric arrangement of the aortic arch branches was demonstrated, comprising a full vascular ring. Since the patient had been completely asymptomatic and with no symptoms of compression of the esophagus or trachea, no surgical management was advised. The abdomen CTA imaging revealed absence of the celiac trunk with direct origin of the common hepatic and the left gastric artery from the superior mesenteric artery as well as asplenia. We presented a case of asymptomatic DAA of completely patent arches with the right vertebral artery branching separately of and the left SCA originating from KD in the descending aorta. The term KD can be identified also in other arch anomalies than the one originally described. Since anatomical anomalies can be frequently combined, thorough imaging inspection with CTA of both thorax and abdomen is suggested.
Keywords: gross anatomyvascular ringsdouble aortic archaortic congenital anomaliesanatomical variations
References
- Adachi I, Krishnamurthy R, Morales DLS. A double aortic arch mimicking a right aortic arch with an aberrant subclavian artery. J Vasc Surg. 2011; 54(4): 1151–1153.
- Atkin GK, Grieve PP, Vattipally VR, et al. The surgical management of aortic root vessel anomalies presenting in adults. Ann Vasc Surg. 2007; 21(4): 525–534.
- Backer CL, Bharadwaj SN, Eltayeb OM, et al. Double aortic arch with Kommerell diverticulum. Ann Thorac Surg. 2019; 108(1): 161–166.
- Dixon CM, Dyar D, Aurigemma D, et al. Double choker: double aortic arch with bilateral aortic coarctation associated with heterotaxy-asplenia syndrome and complex atrioventricular canal defect. CASE (Phila). 2020; 4(3): 142–145.
- Dumfarth J, Chou AS, Ziganshin BA, et al. Atypical aortic arch branching variants: a novel marker for thoracic aortic disease. J Thorac Cardiovasc Surg. 2015; 149(6): 1586–1592.
- Garti IJ, Aygen MM, Vidne B. Type C double aortic arch. Double aortic arch with aberrant left subclavian artery. Cardiovasc Radiol. 1978; 1(3): 143–145.
- Hashemi S, Parks WJ, Sallee D, et al. Double aortic arch with previously undescribed head and neck vessel branching. Can J Cardiol. 2017; 33(4): 555.e21–555.e23.
- Kafka H, Uebing A, Mohiaddin R. Adult presentation with vascular ring due to double aortic arch. Congenit Heart Dis. 2006; 1(6): 346–350.
- Kajikawa Y, Takemoto S, Suganami Y, et al. Asymptomatic double aortic arch. Intern Med. 2005; 44(4): 356–357.
- Kaldararova M, Simkova I, Varga I, et al. Double aortic arch anomalies in children: a systematic 20-year single center study. Clin Anat. 2017; 30(7): 929–939.
- Kleine P, Balci M, Moritz A. Primary complete repair of partial double aortic arch and Kommerell diverticulum. Ann Thorac Surg. 2011; 91(2): 627–629.
- Komiyama M, Yasui T. Left subclavian artery originating from Kommerell diverticulum in the left aortic arch. J Thorac Cardiovasc Surg. 2006; 132(6): 1477.
- Mangialardi N, Ronchey S, Kasemi H, et al. Hybrid treatment option for aortic arch anomalies and descending thoracic aortic aneurysm. J Vasc Interv Radiol. 2013; 24(7): 1063–1065.
- Mao Yi, Yao Y, Li X, et al. Absence of the celiac trunk: Definition, classification, multidetector computed tomography angiographic findings, and their probable embryological mechanisms. Vascular. 2023; 31(6): 1214–1221.
- Natsis KI, Tsitouridis IA, Didagelos MV, et al. Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review. Surg Radiol Anat. 2009; 31(5): 319–323.
- Priya S, Thomas R, Nagpal P, et al. Congenital anomalies of the aortic arch. Cardiovasc Diagn Ther. 2018; 8(Suppl 1): S26–S44.
- Saeed G, Neuzner J, Gradaus R. Double aortic arch and Kommerell's diverticulum. Asian Cardiovasc Thorac Ann. 2014; 22(7): 882–883.
- Saran N, Dearani J, Said S, et al. Vascular rings in adults: outcome of surgical management. Ann Thorac Surg. 2019; 108(4): 1217–1227.
- Sierra-Galan LM, Shveid-Gerson D, Gomez-Garza G, et al. Double incomplete aortic arch and Kommerell's Diverticulum as a cause of chronic cough. Arch Cardiol Mex. 2015; 85(2): 158–160.
- Tanaka K, Yoshitaka H, Chikazawa G, et al. Hybrid repair of right aortic arch aneurysm with a Kommerell's diverticulum. Asian Cardiovasc Thorac Ann. 2014; 22(6): 725–727.
- Tigkiropoulos K, Kousidis P, Lazaridis I, et al. Hybrid repair of distal aortic arch dissection aneurysm with dissected kommerell diverticulum. Vasc Endovascular Surg. 2020; 54(4): 375–377.
- Venieratos D, Panagouli E, Lolis E, et al. A morphometric study of the celiac trunk and review of the literature. Clin Anat. 2013; 26(6): 741–750.
- Vigneswaran TV, Jabak S, Syngelaki A, et al. Prenatal incidence of isolated right aortic arch and double aortic arch. J Matern Fetal Neonatal Med. 2021; 34(18): 2985–2990.
- Wang Yi, Cheng C, Wang Lu, et al. Anatomical variations in the origins of the celiac axis and the superior mesenteric artery: MDCT angiographic findings and their probable embryological mechanisms. Eur Radiol. 2014; 24(8): 1777–1784.
- Yu Di, Guo Z, You X, et al. Long-term outcomes in children undergoing vascular ring division: a multi-institution experience. Eur J Cardiothorac Surg. 2022; 61(3): 605–613.
- Yu PJ, Balsam LB, Mussa FF, et al. Aberrant left subclavian artery associated with a Kommerell's diverticulum and a left-sided aortic arch. J Card Surg. 2012; 27(5): 607–608.
